When necessary to clear secretions, some nurses in my unit suction endotracheal tubes for up to 15 seconds. I say that's too long-suctioning should be limited to 10 seconds. What do the experts say? -L.N., TEX.

As you know, suctioning should be performed only as needed because it can trigger dysrhythmias and other serious problems in critically ill patients. Two respected nursing textbooks endorse suctioning for up to 15 seconds. But you're wise to minimize risks if you can adequately clear secretions in 10 seconds or less. Also follow accepted standards and guidelines for preventing ventilator-associated pneumonia as recommended by the American Association of Critical-Care Nurses and other authorities. For example:

* keep the head of the bed elevated to 30[degrees] to 45[degrees] unless contraindicated

* for patients expected to be intubated for more than 48 hours, use an endotracheal tube with a dorsal lumen above the cuff to allow drainage of secretions that accumulate in the subglottic area by continuous suctioning.